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Analysis: Cannabis Consumers Less Likely to Be Diagnosed with Liver Cancer

Cleveland, OH: Adults with a recent history of cannabis use are twice less likely to be diagnosed with hepatocellular carcinoma (the most common type of liver cancer) than are those with no history of use, according to data published in the scientific journal Cureus.

A team of researchers affiliated with the Cleveland Clinic and with Georgetown University Hospital in Washington, DC assessed the relationship between cannabis consumption and HCC in a cohort of over one million subjects.

Investigators reported that those who reported current cannabis use were "55 percent less likely to have HCC compared to non-cannabis users."

Authors concluded: "To the best of our knowledge, this is the first and largest population-based cross-sectional study of hospitalized patients to explore the association between cannabis use and HCC. ... Due to the cross-sectional structure of our study, we are unable to draw direct causation effects. Hence, we suggest prospective clinical studies to further understand the mechanism by which various active ingredients, particularly CBD in cannabis, may possibly regulate hepatocellular carcinoma development."

Cannabinoids possess anti-cancer activity in cellular models and a limited number of case reports have documented antineoplastic activity in patients. Observational data has also shown an association between cannabis use and a reduced risk of head and neck cancers.

Numerous human studies have also shown an inverse relationship between cannabis consumption and various types of liver diseases.

Full text of the study, "Lower rates of hepatocellular carcinoma observed among cannabis users: A population-based study," appears in Cureus.

SCOTUS: Justices Decline to Weigh in on Whether Medical Cannabis Costs Can Be Reimbursed by Employers

Washington, DC: Justices on the US Supreme Court have declined to weigh in on the issue of whether employees can be reimbursed for their medical marijuana-related costs through their workers' compensation insurance plans.

Litigants sought the Court's intervention following divergent opinions from several state supreme courts. Empire State NORML and two other groups – the New York City Cannabis Industry Association and the Hudson Valley Cannabis Industry – had filed a friend-of-the-court (amicus) brief urging justices to take the case and to use it as an opportunity to settle broader conflicts between state and federal marijuana laws.

The denial of certiorari indicates that most justices did not believe that the lower court decisions merited review by the high court.

David C. Holland, Esq, the Executive and Legal Director of Empire State NORML and the author of the brief said: "By failing to take up the case, SCOTUS only further exacerbated the split between the highest state courts as it continues to evade the fundamental question with regard to cannabis' medical validity, a key factor in the Schedule I designation. Empire State NORML and the New York and Hudson Valley Cannabis Industry Associations will continue to advocate for those cases that will eventually bring resolution to the issue once and for all."

In 2021, courts in three separate states upheld employees' ability to be financially reimbursed for their use of medical cannabis, while the court in another state ruled against the issue.

Currently, five states - Connecticut, New Hampshire, New Jersey, New Mexico, and New York – explicitly allow for employees to have their medical cannabis expenses reimbursed. By contrast, seven states expressly prohibit workers' compensation insurance from reimbursing medical marijuana-related costs: Maine, Massachusetts, Minnesota, Florida, North Dakota, Ohio, and Washington.

In all other jurisdictions, the law is either silent on the issue or states that insurers are "not required" to reimburse employees who are injured on the job for the costs related to their use of medical cannabis.

Survey: Over 80 Percent of Americans Support Uniform Quality Controls for Cannabis Products

Washington, DC: More than eight in ten Americans believe that there should be uniform standards in place regulating the manufacturing of commercially available cannabis products, according to national polling data commissioned on behalf of the regulatory compliance group SIPCA and the Foundation of Cannabis Unified Standards (FOCUS).

Most respondents (72 percent) said that cannabis products should be grown and produced using "consistent product safety standards (regardless of which state they are legally purchased in)," and 84 percent support the notion of the "federal government setting standards for product safety and quality that must be met for any cannabis products produced or sold in the United States."

Because cannabis remains classified as a Schedule I illicit substance under federal law, regulations governing the manufacturing and testing of marijuana products vary from state to state.

Separate polling has similarly shown that a majority of Americans desire greater regulatory authority over the safety and quality of hemp-derived CBD products, most of which are currently subject to little or no federal or state regulatory oversight.

"The U.S. has a plethora of consumer protection laws and organizations, at both the federal and state level, that regulate consumer affairs. So, it is understandable that Americans expect these same consumer protections in cannabis, like they do for everything they purchase," said Lezli Engelking, President & Founder of FOCUS. "The lack of protections for cannabis consumers is simply one more example of the extreme risks to public health and safety Americans are exposed to [because of] the lack of action around cannabis at the federal level."

Consistent with other national polls, a super-majority of respondents (78 percent) to the SIPCA/FOCUS poll agreed that marijuana should be legalized under federal law.

More information on the SIPCA/FOCUS polling data is available online.

Review: Cannabis Provides Benefits for Migraine Sufferers

Tucson, AZ: Cannabis preparations likely provide for the prophylactic and abortive treatment of migraines, according to a review of the relevant literature published in the journal Frontiers in Neurology.

A team of investigators with the University of Arizona reviewed the findings of 12 previously published studies involving 1,980 participants.

Authors reported evidence of plant cannabinoids' ability to reduce migraine frequency and to abort the onset of migraine headaches. The use of various preparations of cannabis was also associated with significant reductions in migraine-induced vomiting, pain, and nausea.

They concluded: "[T]here is some evidence for MC's [medical cannabis'] beneficial effect on treating migraine in adults. However, further research is needed to assess effective dosing and safety critically. Mindful of the upsurge of interest in MC use to treat migraines, there is an urgent need to implement well-designed studies to evaluate the effectiveness and safety of medical marijuana for treating adults with migraines."

The results of a prior literature review, which assessed 34 scientific papers on cannabis and migraine, similarly identified "encouraging data on medicinal cannabis' therapeutic effects on alleviating migraines in all of the studies reviewed."

Numerous surveys of patients report that those suffering from migraines often turn to cannabis for symptomatic relief, and many patients say that it is more effective than prescription medications.

Full text of the study, "Cannabis for the treatment of migraine in adults: A Review of the evidence," appears in Frontiers in Neurology.

Colorado: Youth Marijuana Use Declines Sharply Among Teens

Denver, CO: The percentage of young people who acknowledge consuming cannabis and having ready access to it declined sharply between 2020 and 2021, according to statewide data provided by the Colorado Department of Public Health and Environment (CDHPE).

Researchers reported a 35 percent year-over-year decline in the percentage of teens who admitted having consumed cannabis products within the past 30 days. They also reported a 22 percent drop in the percentage of teens who said that they could easily access cannabis. There was a 50 percent drop in the percentage of teens who admitted having driven after using cannabis.

"These data are consistent with other surveys showing that marijuana regulation policies can be implemented in a manner that provides access for adults while simultaneously limiting youth access and misuse," NORML's Deputy Director Paul Armentano said. "These findings ought to reassure lawmakers and others that cannabis access for adults can be regulated in ways that do not inadvertently impact young people's habits."

Nationwide, there was a 38 percent year-over-year reduction in self-reported marijuana use among eighth graders, a 38 percent decline among 10th graders, and a 13 percent decrease among 12th graders, according to data provided by the University of Michigan's annual Monitoring the Future survey.

Since Coloradoans legalized adult-use marijuana sales, lifetime cannabis use has fallen an estimated 30 percent among high-schoolers and an estimated 40 percent among middle-schoolers. Adult-use legalization in other states has also failed to overlap with any significant uptick in either young people's use of cannabis or access to marijuana products.

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Study: Aerosolized Cannabis Significantly Reduces Pain Levels, Improves Quality of Life in Neuropathy Patients

Haifa, Israel: The administration of aerosolized cannabis via a novel inhaler is associated with long-term pain reductions in patients with neuropathy and other chronic conditions, according to data published in the journal Pain Reports.

Israeli investigators assessed the efficacy of cannabis delivered via a novel metered selective dose inhaler (The Syqe Inhaler) in a cohort of chronic pain patients. The mean daily stable dose used by patients in the study was 1.5 mg of aerosolized delta-9-THC.

Use of the inhaler over a period of several months was associated with reduced pain scores and improvements in patients' quality of life. Some patients reported mild side-effects (typically dizziness and sleepiness) at the onset of the study, but few participants continued to report these effects throughout the duration of the trial.

Authors concluded: "Medical cannabis treatment with the Syqe Inhaler demonstrated overall long-term pain reduction[s], quality of life improvement[s], and opioid-sparing effect[s] in a cohort of patients with chronic pain, using just a fraction of the amount of MC [medical cannabis] compared with other modes of delivery by inhalation. These outcomes were accompanied by a lower rate of AEs [adverse events] and almost no AE reports during a long-term steady-state follow-up. Additional follow-up in a larger population is warranted to corroborate our findings."

According to recently compiled survey data, nearly one in three chronic pain patients report using cannabis for treatment management. Among patients in US states where medical cannabis access is permitted, over 60 percent are qualified to use it to treat pain.

Full text of the study, "Long-term effectiveness and safety of medical cannabis administered through the metered-dose Syqe Inhaler," appears in Pain Reports.

Randomized Controlled Trial: Topical CBD Treatment Provides Relief in Arthritis Patients

Charlottesville, VA: The administration of a topical formula containing hemp-derived CBD is associated with significant improvements in patients with thumb basal joint arthritis, according to randomized clinical trial data published in the Journal of Hand Surgery.

Researchers with the University of Virginia School of Medicine assessed the twice-daily application of 1 ml of topical CBD (6.2 mg/ml) with shea butter versus placebo in 18 patients with symptomatic thumb basal joint arthritis.

Investigators reported, "Cannabidiol treatment resulted in improvements from baseline among patient-reported outcome measures, including Visual Analog Scale pain; Disabilities of the Arm, Shoulder, and Hand; and Single Assessment Numeric Evaluation scores, compared to the control arm during the study period."

They concluded, "In this single-center, randomized controlled trial, topical CBD treatment demonstrated significant improvements in thumb basal joint arthritis-related pain and disability without adverse events."

The results contrast those of a 2021 Danish study reporting that the oral administration of synthetic CBD did not mitigate pain in patients with hand osteoarthritis.

Canadian survey data published earlier this month in the journal Clinical and Experimental Rheumatology reported that one in five patients with arthritis acknowledge using cannabis therapeutically.

Full text of the study, "A randomized controlled trial of topical cannabidiol for the treatment of thumb basal joint arthritis," appears in the Journal of Hand Surgery.

Analysis: Cannabis Use Inversely Associated with Obesity in Hep C Patients

Paris, France: Cannabis use is inversely associated with obesity in patients with chronic hepatitis C virus (HCV) infection, according to data published in the Journal of Cannabis Research.

A team of French researchers assessed the relationship between lifetime cannabis use and obesity in a cohort of over 6,300 HCV patients.

Authors reported, "[F]ormer and, to a greater extent, current cannabis use were consistently associated with smaller waist circumference, lower BMI, and lower risks of overweight, obesity, and central obesity in patients with chronic HCV infection. … To our knowledge, this is the first time that such associations have been highlighted for HCV-infected patients."

The study's findings are consistent with those of analyses of other cohorts – such as those here, here, and here – reporting that marijuana use is typically associated with lower BMI and with lower rates of obesity.

Full text of the study, "Cannabis use as a factor of lower corpulence in hepatitis C-infected patients: Results from the ANRS C022 Hepather cohort," is available in the Journal of Cannabis Research.

Study: Regular Cannabis Consumers Perform Better Than Occasional Users on Distracted Driving Tasks

Aurora, CO: Those with a history of frequent cannabis use exhibit only minor changes in driving performance shortly following marijuana smoking, according to driving simulator data published in the journal Traffic Injury Prevention.

Investigators with the University of Colorado, Anschutz Medical Campus and the University of Iowa assessed driving simulated performance in a cohort of frequent and infrequent cannabis consumers. Participants provided their own cannabis, which contained between 15 and 30 percent THC. Following cannabis smoking ad-libitum, subjects completed a series of distracted driving scenarios.

Authors reported: "Those with a pattern of occasional use were significantly more likely to experience a lane departure during distraction periods after acute cannabis use relative to baseline, while those with daily use did not exhibit a similar increase." Consistent with other studies, researchers further acknowledged, "Participants with a pattern of daily use decreased their speed, which may be interpreted as a drug effect or as a compensatory strategy."

Separate studies have previously reported that repeated cannabis exposure is associated with either partial or even full tolerance in particular domains, including cognitive and psychomotor performance.

The study's authors concluded: "The results provide evidence that a pattern of occasional use was associated with performing worse after acute cannabis smoking as it relates to lane departures. Those with a pattern of occasional use also behave differently with respect accelerator position, and there was a trend that those with a pattern of daily use decreased the speed. This would be consistent with the hypothesis of tolerance, with individuals with daily use being somewhat less affected by or better able to mitigate the effects of acute cannabis smoking. This may indicate that those who use daily may perceive a potential adverse impact of acute cannabis use on driving performance and may attempt to compensate by slowing down to have more time to react to changes in the roadway. Further research is needed to understand the effects during longer and more complex secondary tasks."

Though not a primary focus of the study, investigators did assess subjects' baseline THC/blood levels upon their admission to the lab. Consistent with prior research, those subjects who reported daily cannabis use tested positive for THC in their blood (mean THC blood level: 5ng/ml) despite having abstained from marijuana for at least the past 12 hours.

NORML has long advocated against the imposition of THC blood thresholds as predictors of impairment, and per se traffic safety limits in particular, because they are not consistently correlated with changes in subjects' performance and because residual THC levels may linger in blood for several hours or even days post-abstinence. Alternatively, NORML has called for the expanded use of performance-based tests, like DRUID.

Full text of the study, "Influence of cannabis use history on the impact of cannabis smoking on simulated driving performance during a distraction task," appears in Traffic Injury Prevention.

Analysis: Medical Cannabis Access Positively Correlated with Traffic Safety

Philadelphia, PA: The enactment of medical cannabis access laws is associated with reductions in auto insurance premiums and improvements in overall traffic safety, according to data published in the journal Health Economics.

A team of economists associated with Temple University in Philadelphia, the University of Arkansas, Little Rock and Eastern Kentucky University assessed the relationship between legalized medical cannabis access (via licensed dispensaries) and auto insurance premiums between the years 2014 and 2019.

Researchers reported that medical access was associated with a decrease in auto premiums. "We estimate that legalizing medical cannabis reduces annual auto insurance premiums by $22 per household, a reduction of 1.7 percent for the average household," they wrote. "The effect is stronger in areas directly exposed to a dispensary, suggesting increased access to cannabis drives the results. In addition, we find relatively large declines in premiums in areas with relatively high drunk driving rates prior to medical cannabis legalization. This latter result is consistent with substitutability across substances that is argued in the literature."

They concluded: "While this [$22] reduction may be inconsequential to an individual policy-holder, the aggregate effects are economically meaningful. For just the policyholders in our switching states, we estimate a combined annual reduction in premiums of $500 million. Extending our results to other states, we find that medical cannabis legalization has reduced auto insurance premiums by $1.5 billion in all states that have currently legalized, with the potential to reduce premiums by an additional $900 million if the remaining states were to legalize. Because auto insurance premiums are directly tied to property damage and health outcomes, we find evidence of a positive social impact of medical cannabis on auto safety."

The study's findings are consistent with those of prior analyses similarly reporting a decrease in traffic fatalities following the implementation of medical cannabis access, including reductions in motor vehicle accidents involving drivers under the influence of alcohol and opioids.

Full text of the study, "Medical cannabis and automobile accidents: Evidence from auto insurance," appears in Health Economics.

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Study: Long-Term Cannabis Use Associated with Reduced Prescriptions, Improved Symptoms in Cancer Patients

Haifa, Israel: The use of cannabis products over a six-month period is associated with statistical improvements in cancer-related symptoms as well as significant reductions in subjects’ use of prescription painkillers, according to longitudinal data published in the journal Frontiers in Pain Research.

Israeli researchers assessed the long-term use of cannabis in a cohort of several hundred oncology patients.

Consistent with studies of other patient cohorts, cannabis use was associated with symptom mitigation, improved quality of life, and reduced prescription drug use. Among those participants who completed the trial, nearly half ceased their use of analgesics.

Authors concluded: "The main finding of the current study is that most cancer comorbid symptoms improved significantly during six months of MC [medical cannabis] treatment. ... Additionally, we found that MC treatment in cancer patients was well tolerated and safe. ... In conclusion, this prospective, comprehensive and large-scale cohort demonstrated an overall mild to modest long-term statistical improvement of all investigated measures including pain, associated symptoms and, importantly, reduction in opioid (and other analgesics) use."

Full text of the study, "The effectiveness and safety of medical cannabis for treating cancer related symptoms in oncology patients," appears inFrontiers in Pain Research.

Clinical Trial: CBD-Rich Cannabis Extracts Safe and Effective in Pediatric Patients with Autism Spectrum Disorder

João Pessoa, Brazil: The administration of CBD-rich cannabis extracts is safe and effective in mitigating symptoms in children with autism spectrum disorder (ASD), according to placebo-controlled, randomized clinical trial data published in the journal Trends in Psychiatry and Psychotherapy.

Brazilian researchers evaluated the use of CBD extracts versus placebo in 60 children (ages 5 to 11) with ASD over a 12-week period.

Compared to the placebo group, subjects receiving CBD extracts experienced significant improvements in their ability to engage in social interactions. They also experienced reduced anxiety and agitation. Only a minority of subjects administered CBD exhibited adverse events, namely dizziness and insomnia.

The study’s findings are consistent with those of other trials similarly reporting improvements in patients’ ASD symptoms following their use of cannabinoid products. Survey data published in October by the publication Autism Parenting Magazine reported that 22 percent of US caregivers or parents have provided CBD to an autistic child. Survey data from the United Kingdom recently reported that autistic adults were nearly four times as likely as controls to report having used CBD within the past year.

Full text of the study, "Evaluation of the efficacy and safety of cannabidiol-rich cannabis extract in children with autism spectrum disorder: Randomized, double-blind and controlled placebo clinical trial," appears inTrends in Psychiatry and Psychotherapy.

Survey: One in Five Patients with Arthritis Acknowledge Using Medical Cannabis

Toronto, Ontario: Arthritis patients frequently reported consuming cannabis for symptomatic relief, according to survey data published in the journal Clinical and Experimental Rheumatology.

A team of Canadian investigators surveyed 799 patients at eight rheumatology clinics in Ontario. (Cannabis is legal in Canada for both medical purposes and for adults.)

Just over 20 percent of those surveyed acknowledged either having consumed cannabis within the past two years or being current users of cannabis products. Compared to non-users, those who consumed cannabis were more likely to be younger and were more likely to report suffering from severe pain.

Cannabis consumers reported using it to treat pain, anxiety, and to promote sleep. Seventy-eight percent of them reported medical cannabis to be "at least somewhat effective" at mitigating their symptoms.

The study’s findings are consistent with French survey data, published in 2021, which reported that "nearly 20 percent of patients suffering from rheumatologic diseases actively consume cannabis."

Longitudinal data published in April reported that osteoarthritis patients decrease their daily opioid intake and experience improvements in their overall quality of life following the initiation of medical cannabis therapy. Authors of the study concluded: "Our findings indicate that providing access to MC [medical cannabis], helps patients with chronic pain due to OA [osteoarthritis] reduce their levels of opioid usage in addition to improving pain and QoL [quality of life]. Furthermore, a majority of patients did not feel intoxicated or high from MC, and of those who did, only a small percentage said it interfered with their daily activities. ... Our findings support the literature in that MC reduces the use of opioids for the treatment of chronic pain."

Full text of the study, "Medical cannabis use by rheumatology patients in routine clinical care: Results from the Ontario Best Practices Research Initiative," appears in Clinical and Experimental Rheumatology.

Ninth Circuit Rules on Legal Status of Hemp-Derived Delta-8 THC Products

San Francisco, CA: A three judge panel for the Ninth Circuit Court of Appeals has rejected arguments that delta-8 THC products which are chemically synthesized from hemp-derived CBD fall beyond the scope of the 2018 Farm Bill.

Plaintiffs in the case were asking the court to protect trademarks for their proprietary delta-8 THC products. Defendants in the case argued that the company’s trademarks were not protectible because the 2018 Farm Bill was never intended to legalize such products for human consumption.

The three-judge panel was unpersuaded by the defendant’s arguments, opining: "[The defendant] is effectively asking us to recognize the following limitation: that substances legalized by the Farm Act must be somehow suited for an industrial purpose, not for human consumption. ... [But] this limitation appears neither in hemp’s definition, nor in its exemption from the Controlled Substances Act. ... Regardless of the wisdom of legalizing [ingestible] delta-8 THC products, this Court will not substitute its own policy judgment for that of Congress. If [the defendant] is correct, and Congress inadvertently created a loophole legalizing vaping products containing delta-8 THC, then it is for Congress to fix its mistake."

The Court also rejected the argument that delta-8 THC products were outside of the scope of the Act because many such products are the result of a chemical synthesis and are not extracted directly from hemp plants (which contain only nominal amounts of delta-8 THC). Judges opined that the process used to manufacture the end product was irrelevant as long as it was initially sourced from either hemp or hemp-derived CBD. "[T]he source of the product - not the method of manufacture - is the dispositive factor for ascertaining whether a product is synthetic," it ruled.

Provisions of the 2018 Act explicitly legalize the possession of cannabinoids "that are naturally occurring constituents" of hemp, but it "does not impact the control status of synthetically derived" cannabinoids.

NORML has expressed caution regarding the safety of commercially available, hemp-derived delta-8 THC products because neither the products nor their manufacturing processes are regulated. Lab analyses of unregulated delta-8 products have consistently found them to contain lower levels of the compound than advertised on the products’ labels. Some products have also been found to possess heavy metal contaminants and unlabeled cutting agents.

In response to the ruling, attorney Garrett Graff - whose firm specializes in issues related to hemp - told New Frontier Data: "I’m not sure that this opinion will change the cannabinoid landscape all that much. Companies selling hemp-derived cannabinoids such as delta-8 THC were already emboldened to do so, despite the regulatory uncertainties. These companies didn’t necessarily need the court’s opinion to feel emboldened to do so. That said, even with this court’s position under federal law, this opinion does not necessarily change the laws of states which have affirmatively regulated (or prohibited) delta-8 THC and other intoxicating cannabinoids. Those state-level regulations still present potential legality challenges."

While several states have recently moved to prohibit the sale of hemp-derived delta-8-products, several others remain largely silent on the issue.

The case is AK Futures LLC v. Boyd Street Distro, LLC.

Study: High Doses of CBD Do Not Impact Cognitive Function, Simulated Driving Performance

Sydney, Australia: The oral administration of up to 1500 mg of CBD does not induce feelings of intoxication and is not associated with changes in simulated driving performance, according to data published in the Journal of Psychopharmacology.

A team of Australian researchers assessed the impact of varying dosages of CBD (ranging from 15 mg to 1500) versus placebo in 17 subjects. Study participants engaged in a series of simulated driving tests at approximately one hour and four hours after dosing. Investigators separately assessed subjects’ cognitive performance via their completion of a variety of computerized tasks. Participants were also asked whether they felt either "stoned" or "sedated" at any time during the trial.

Consistent with prior research, authors reported that CBD administration was not associated with either weaving or any other significant changes in simulated driving performance. Participants also failed to show any significant differences in either cognitive function or in their subjective feelings of well-being following CBD dosing.

Authors concluded: "The results of this study suggest that acute, oral CBD treatment at doses up to 1500 mg does not induce feelings of intoxication and is unlikely to impair cognitive function or driving performance. However, further research is required to confirm no effect of CBD on safety-sensitive tasks in the hours immediately post-treatment and with chronic administration."

Full text of the study, "Effects of cannabidiol on simulated driving and cognitive performance: A dose-ranging randomized controlled trial," appears in the Journal of Psychopharmacology.

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